How Do Families Allocate Elder Care Responsibilities Between Siblings

1
How Do Families Allocate Elder Care
Responsibilities Between Siblings?

• Richard W. Johnson, Anthony T. Lo Sasso, and
  Ithai Z. Lurie
• Presented at the AcademyHealth annual meeting
• June 7, 2004

2
Family Care of the Nations Elders Is an
Increasingly Important Public Policy Issue

• About 7 million adults ages 65 and older need
  long-term care services
• The number will grow as the nation continues to
  age
• Family members provides much of the care received
  by frail elders
• 57 of primary caregivers for frail older adults
  in the community are spouses or adult children
  (McGarry 1998)

3
Ongoing Changes in the Family May Transform the
Provision of LTC Services

• Increased labor supply by women may limit their
  ability to provide informal care to parents
• Between 1960 and 1997, share of women employed
  increased from 36 to 65
• Relatively low fertility rates among Baby Boomers
  will limit the availability of family caregivers
  when they reach old age
• Increase in divorce may weaken family ties
• These social and demographic trends could have
  important effects on caregiving
• Could increase formal care, sharing of duties,
  caregiver burden
• Could decrease care received by elders

4
Objectives

• Understand what factors influence which child
  provides informal care to frail elderly parents
• Examine role of relative child characteristics
• Employment
• Education
• Living arrangements

5
Previous Research

• Daughters are more likely to provide care than
  sons
• Children who received financial help from their
  parents in the past are more likely to provide
  care to their parents (Henretta et al. 1997)
• Children who co-reside or live nearby are more
  likely to provide care (McGarry 1998)
• Number of siblings reduces odds that given child
  helps (Wolf, Freedman, Soldo 1997)
• But increases odds that elder receives help from
  any child
• Mixed findings on impact of childs education
• Henretta et al. (1997) education decreases
  caregiving
• McGarry (1998) no effect

6
Approach

• Examine the provision of help by children at the
  onset of parental frailty
• Relate help to child characteristics in the
  previous wave
• Limits endogeneity issues associated with childs
  living arrangements and employment

7
Conceptual Framework

• Altruistic children care about the well-being of
  their frail parents, as well as their own
  consumption and leisure
• Siblings cooperate to maximize family welfare
• Implies that low-wage kids (not high-wage
  employed kids) provide care
• We are not testing models of exchange or
  strategic behavior

8
Data and Sample

• Health and Retirement Study
• AHEAD (1993-2002) and CODA (1998-2002) cohorts
• Adults ages 70 and older
• Report no frailty at baseline, but report frailty
  in subsequent wave
• At least 2 surviving children ages 22 or older
• Parental characteristics measured at onset of
  frailty
• Child characteristics measured in previous wave
• Sample sizes
• Full sample 1,872 parents 6,659 children
• Unmarried sample 998 parents 3,571 children

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Key Definitions

• Frailty Any difficulty with
• ADLs (walking across room, bathing, eating,
  dressing, getting in/out of bed, using toilet)
• IADLs (preparing meals, shopping for groceries,
  using phone, taking medications)
• Help from children regular help with ADLs or
  IADLs
• Primary caregiver if child helps more often
  than anyone else

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Receipt of Help from Children
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Share of Frail Parents Receiving Regular Help
from Children,By Family Size and Number of Child
Helpers
No. of Child Helpers
12
Share of Unmarried Frail Parents Receiving
Regular Help from Children, By Family Size and
Number of Child Helpers
No. of Child Helpers
13
Characteristics of Frail Older Adults, By
Provision of Help From Children
Difference significant at 5 level
14
Share of Frail Older Adults With Given ADL
Limitation, By Provision of Help From Children
Difference significant at 5 level
15
Share of Frail Older Adults With Given IADL
Limitation, By Provision of Help From Children
Difference significant at 5 level
16
Share of Frail Older Adults With Given Living
Arrangement, By Provision of Help From Children
Difference significant at 5 level
17
Random-Effects Logit Models of Help Provided by
Children

• Unit of analysis Adult child
• Random family effect
• Correct standard errors for clustering within
  families (Huber correction)
• Dependent variables
• Any regular ADL or IADL help
• Primary caregiver (ADL or IADL)
• Full frail sample, unmarried frail sample

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Random-Effects Logit Models Covariates

• Parental Characteristics
• Demographics (marital status, age, race, gender)
• Education
• Health and disability (memory disease, ADL IADL
  limits)
• Income and assets
• Child Characteristics
• Demographics (gender, age, youngest/oldest child
  dummies, marital status, own children, no. of
  brothers and sisters)
• Living arrangements (co-reside with parent sib
  co-resides)
• Education (level, indicator for most-educated
  child)
• Employment (employed, only child employed)
• Highest-educated child X Employed

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Coefficients Parents Characteristics
20
Coefficients Parents Education
21
Coefficients Number of Limitations
22
Coefficients Type of ADL Limits, Memory Disease
23
Coefficients Parents Income Quintiles
24
Coefficients Parents Asset Quintiles
25
Coefficients Child Characteristics
26
Coefficients Childs Age
27
Coefficients Childs Employment and Education
28
Conclusions and Next Steps

• Employed children with more schooling than their
  sibs are significantly less likely to help their
  parents than other children
• suggests that families weigh opportunity costs
  when allocating caregiving responsibilities
• Do high-wage children provide financial help to
  parents when low-wage sibs donate time?
• How does unpaid family care interact with paid
  home care?